Social Anxiety Disorder

Social anxiety disorder, which was previously referred to as social phobia is a long term overwhelming fear of being in social situations.  Whilst all of us can be affected by feeling nervous or anxious in certain situations such as public speaking, being the centre of attention, meeting someone new, on a date or for an important job interview, it’s a perfectly normal response to have.

For people with social anxiety disorder however, they can feel this way in everyday situations, and it causes them extreme anxiety and discomfort.  It can have a serious and negative affect on their daily lives, causing them problems in their every day routines, relationships and school or work lives.

Generally the condition starts in teenagers, so before the age of twenty, and is believed to affect around five to ten percent of the population and is more common amongst females than males.  Initially they may have been thought to just be shy or timid as children but they don’t grow out of it like the majority of children, their symptoms increase and their anxiety gets worse.  They will have an intense fear of social situations and meeting new people as they feel like they are being watched and judged by them, and they fear being humiliated or rejected.  Whilst social anxiety is a chronic mental health condition it can be managed with the help of psychotherapy and medications.

Causes of Social Anxiety Disorder

As with most mental health conditions there is no single cause for developing social anxiety disorder, it’s believed that it’s more likely to be caused by several different factors that could be both genetic or environmental. Contributory factors can include:

·      If you have a close family member who has it then you are more likely to develop it

·      As a result of learned behaviour in childhood

·      If you were bullied, abused, humiliated or rejected

·      Children who suffered trauma or abuse or were very shy or timid can be more at risk of developing it

·      People who have disabilities, are disfigured or have Parkinsons or Tourette’s can sometimes develop it as they often feel self-conscious, embarrassed or anxious

·      Having parents that were overly controlling or protective, or had poor parenting skills or not bonding with your parents at an early age

·      People who have an overactive amygdala the part of the brain that is responsible for our emotional response including fear and anxiety

Symptoms of Social Anxiety Disorder

How people feel in social situations can be different depending on their personality, some people love to be the centre of attention, whilst other people can be more reserved.  Just because someone might be shy or timid and feel less confident socially, it does not mean that they have social anxiety.  Children can often feel a little overwhelmed if they are surrounded by people that they do not know.  People who do suffer from social anxiety disorder will show obvious signs of fear, avoidance, extreme anxiety and discomfort.

Physical Symptoms

·      Rapid breathing or heart beat

·      Tightness in the chest

·      Light headedness or feeling dizzy

·      Feeling breathless or like you can’t catch your breath

·      Blushing or feeling hot or sweaty

·      Trembling or shaking

·      Feeling like your mind has gone blank

·      Stomach upsets, nausea or needing the toilet

·      Muscle tension

·      Difficulty speaking

·      Feeling like you’re having an out of body experience

Psychological Symptoms

·      Feeling really anxious or agitated

·      Having negative thoughts

·      Poor confidence and self-esteem

·      Fear of being embarrassed or judged

·      Overly sensitive to criticism

·      Fearing they will offend or anger someone

·      Developing depression

·      Needing to drink alcohol before they can face social situations

·      Fear that other people will see how anxious they are

Behavioural Symptoms

·      A reluctance to talk to other people

·      Avoiding eye contact whenever possible

·      Avoiding social situations and interactions especially if they will be the centre of attention

·      Refusing to eat in public or use public toilets

·      Refuse to talk to people they don’t know on the telephone

·      Won’t go out to shop and use on-line shopping

Complications and associated risks of Social Anxiety Disorder

If you have social anxiety disorder and it remains undiagnosed or treated it can get worse and have a serious impact on your life and lead to:

·      Poor confidence and low self-esteem

·      Poor social skills, which can make it difficult to form friendships and develop romantic relationships

·      Negative thinking which can lead to depression and even suicidal thoughts or attempts

·      Substance misuse such as alcohol or drugs

·      Being over sensitive to criticism which can affect your education or employment

·      Problems achieving success academically or in your career

·      Becoming isolated and withdrawn due to lack of socialising

Diagnosing Social Anxiety Disorder

There is no specific test to diagnose social anxiety disorder but you should consult your doctor if you are struggling with anxiety.  Your doctor will need to assess you to see if there are any underlying physical causes for your anxiety, or any other mental health conditions that could be causing it.  They can do this by giving you a physical examination, running routine tests and discussing your symptoms and chatting to you about your mental health.

To diagnose social anxiety disorder you need to meet certain criteria which will include:

·      Anxiety or distress that is severe enough to interfere with your daily life

·      Anxiety that is excessively disproportionate to the situation

·      Avoidance of social situations or only being able to endure them whilst feeling intense fear or anxiety

·      Fear or anxiety that cannot be explained by medication, substance abuse or medical conditions

·      Having a persistent fear of social interactions that has lasted over 6 month

·      Are afraid of acting in a way that will offend, upset or anger other people or have them judge or scrutinise them in a negative way

Treatment for Social Anxiety Disorder

Treatment depends on how severely your symptoms affect you and your ability to function on a daily basis.  People with social anxiety disorder can have mild, moderate or extreme symptoms.  Some people can be triggered only in certain situations, other people may have several triggers, whilst people with extreme symptoms can be triggered in every social situation.  Treatment can include:

Psychotherapy and CBT (cognitive behavioural therapy)

Therapy can help people to recognise and change negative thinking and behaviours, as well as finding any underlying root cause for their anxiety.

CBT is one of the most effective therapies for anxiety and works well in both individual and group therapy sessions.  Exposure based CBT is where you work towards facing the situations you find the most fearful.  The idea is that this will help you to develop coping skills and build your confidence, making you better able to deal with situations you find trigger your anxiety.  It can involve role playing where you can gain confidence by practicing your social skills and feel more comfortable relating to other people.

Medication

Your doctor can prescribe a variety of medications to help you to manage your anxiety, stress or depression.  These can include:

·      Antianxiety medications                                                     Are generally prescribed for short term use as they can        become addictive but can help reduce your anxiety and can often work quickly.

·      Beta Blockers

Whilst they aren’t designed specifically for anxiety they can help to reduce your heart rate and blood pressure which can help with symptoms of a pounding heart and shaky voice or shaking limbs.  They are best used only when needed in advance of a particular situation to control these symptoms and not on a regular basis.

·      Antidepressants

If you develop depression there are several types of antidepressant medication that can be used to treat your symptoms. These can include SSRI’s (selective serotonin reuptake inhibitors) which can lift your mood and reduce your depression, and SNRI’s (serotonin-norepinephrine reuptake inhibitors) which are often prescribed for long term anxiety.

Self-Care

There are things that you can do to help with your social anxiety disorder as well as therapy or medication, and whilst they can seem like small lifestyle changes they can be effective for improving your all round mental health. These include

·      Reaching out to your friends and family for support so that you can build a support network

·      Finding an online or local support group for people who have social anxiety

·      Checking in with your doctor to monitor your symptoms

·      Making sure you take any prescribed medication on a regular basis

·      Avoid using alcohol or drugs and cutting down on nicotine and caffeine

·      Taking regular exercise and ensuring you have a regular sleep routine

·      Follow a healthy balanced diet to help boost your general sense of well being

·      Ensure that if you choose to see a therapist you see them on a regular basis

·      Try things like mindfulness, meditation, yoga, breathing and relaxation exercises

According to research it’s believed that over a third of people who have social anxiety disorder can fail to seek help for as long as ten years.  This is because they don’t realise that the fear and discomfort that they endure is actually a mental health condition and not just part of who they are.  Written by Jan, Jeana and Wendy at Barnsley Hypnosis and Counselling (UK). For more free Information click above link.